‘Only one type of FFP3 mask available which does not fit many people [but] no other option,’ a comment said.

‘The trust won’t mask fit test bank staff but allows them to work in the highest risk areas of respiratory, ITU, combined assessment and A&E,’ one nurse said. ‘There are many contracted staff that haven’t been mask fit tested too.’

What protective equipment should nurses have?

PHE guidance on PPE

The government sets out different levels of PPE depending on where nurses are working.

Nurses working in inpatient settings, including wards, emergency departments and maternity units, with possible or confirmed cases, should wear disposable gloves, apron, a fluid-resistant surgical mask and eye or face protection, according to Public Health England.

Those in affected higher risk areas, which include ICU and emergency department resuscitation areas, should wear gloves, apron, a fluid-resistant gown, a filtering face piece respirator and eye or face protection.

In primary and community care, when carrying out direct patient care for someone with suspected or confirmed COVID-19, or in the community, where someone else in the same household has symptoms, nurses should wear disposable gloves, apron, fluid-resistant surgical mask and risk assess whether to use eye or face protection. They should wear disposable gloves, apron and a surgical mask when they visit a house with any member who is in the extremely vulnerable group.

Many nurses are deeply concerned that guidance for UK nurses differs slightly from that from the World Health Organization (WHO). ‘We have the "correct" PPE according to government guidance. However, we all feel that this is inadequate when caring for patients positive with COVID-19,’ one nurse said.

The WHO says that those providing direct care for people with or suspected of having COVID-19 in acute care and the community should wear eye protection, gloves and medical masks. It also specifies a gown, something only set out for those in higher risk areas in the NHS.

One nurse said: ‘We share disposable visors, cleaning them after each use. We have three to share, there are 20 staff who come into contact with them every 24 hours, who wear them and clean them after they have worn them.’

‘We have to wipe over our visor and put it back in a bucket for others to use,’ a nurse said.

Concern about supplies reaching staff

Susan Masters

The government has been dogged by criticism since the pandemic hit UK shores that not enough PPE was available for healthcare staff.

In March, NHS England said the military would help deliver supplies, including millions more PPE items to hospitals, ambulance trusts, GP practices, pharmacists, care homes and hospices.

Health and social care secretary Matt Hancocok told Downing Street press conference on 10 April that more than 742 million pieces of PPE have been delivered so far during the outbreak.

But the findings of the Nursing Standard online survey, which was carried out 3-6 April, suggest this is not yet enough to make a difference to supplies available to many front-line nurses.

Home secretary Priti Patel, fielding questions at a Downing Street briefing on 11 April, said she was 'sorry' if people felt there had been failings regarding the supply of PPE.

After being asked twice if she would apologise to NHS staff and their families over supplies of PPE, Ms Patel said: 'I'm sorry if people feel that there have been failings. I will be very, very clear about that.'

'But at the same time, we are in an unprecedented global health pandemic right now.

'It is inevitable that the demand and the pressures on PPE and demand for PPE are going to be exponential.'

‘It is simply unacceptable that nurses are being forced to spend their own money to buy even what would be considered to be the bare minimum to protect themselves.

'We keep hearing that millions of pieces of equipment are being delivered but words are not enough. All nursing staff, no matter where they work, must feel safe and need action rather than assurances if they are to be able to do their jobs.’

The military is supposed to deliver millions of PPE items to hospitals. Picture: Alamy

Not meeting PHE guidelines

Public Health England (PHE) guidance sets out gloves, apron, surgical mask and eye protection as the basic kit required by healthcare staff going within two metres of someone with or suspected of having COVID-19 (see box, below).

Many people also spoke about buying equipment that is not recommended PPE by Public Health England, such as hair covers and shoe covers. A couple of respondents were buying shoes that they could leave at work.

A number of nurses reported they were not allowed to use the items they had purchased themselves.

‘We provided our own face shields. But then, they are advising us not to use it. Because it’s not from hospital resources,’ a nurse said.

Hazards of homemade protective equipment

One in ten nurses responding to the Nursing Standard survey said they have made their own PPE due to shortages.

Masks and scrubs are being sewn by nurses, managers and friends, the survey heard.

Nurses reported using snorkelling and cycling goggles, and wearing plastic bags on their feet.

Some reported making visors in a variety of ways, including using acetate sheets and 3D printers. ‘Made own visor from hairband and plastic A4 pocket,’ a comment said.

Before gowns arrived, a nurse said she and colleagues used disposable aprons to cover their arms.

‘Homemade forms of PPE are not likely to provide the correct level of protection’

Jennie Wilson, University of West London

A member of staff in a nursing home with cases of COVID-19 said: ‘The manager spent last night sewing improvised masks. She has ordered supplies and tried desperately to source proper PPE but with no luck.’

The dangers of home-made PPE were pointed out by some nurses. Some comments said they had been banned from wearing homemade creations at work, as they did not meet regulations.

‘I’m wary of home-made PPE owing to a question over its compliance,’ one comment said.

‘I have seen some FB [Facebook] articles suggesting that replacement filters can be made with charcoal, which is dangerous as this will not filter out viruses,’ one comment said.

Professor Jennie Wilson

Professor of healthcare epidemiology at the University of West London and vice president of the Infection Prevention Society Jennie Wilson agrees that people shouldn’t be making their own PPE: ‘I can understand nurses' concerns, but these home-made forms of PPE are not likely to provide the correct level of protection. We understand that some staff feel they need to wear a mask all the time, but World Health Organization and PHE guidance is consistent in saying that there is no evidence that wearing masks routinely confers any benefit.

’What is essential is encouraging cough etiquette, adherence to standard practice in relation to hand hygiene, and being extremely careful not to touch mucous membranes (eyes, nose, mouth) with hands or gloves whilst at work.’

Donated PPE from unexpected sources

More than one in five respondents said their employer had received donations of PPE equipment from other organisations, including from schools, building companies, Nando's restaurant chain, local dentists and vets, and other local businesses.

Goggles and eye protection appeared to be the most frequently donated items, although nurses said not all of it could be used as it did not pass infection prevention control standards.

Some local companies, including breweries and gin distilleries, have made alcohol hand rub, some nurses said.

2 April 2020

‘[A] lack of clarity in what is required for each patient setting has led to confusion and under or overuse of appropriate PPE. We have also been told to ration our use of PPE at times, which shows that we do not have enough.’

This lack of clarity and concerns about shortages are causing a climate of fear in healthcare settings, many respondents suggested.

‘Manager shouted at me for asking for PPE,’ said one nurse. ‘Matron stated masks were for patients and not for staff, which caused much animosity and fear,’ said another.

Government handling is life-threatening for nurses

Nurses generally condemned the government’s handling of the supply of PPE equipment to front-line staff during the pandemic, describing it as shameful, dishonest and life-threatening.

‘We had time to prepare for this. Health is the most important thing for all of us. I have been a nurse for 30 years and now I am frightened of going to work. It’s disappointing.’

Some said the government is doing its best in difficult circumstances, and others said the PPE situation is improving, and they had enough.

‘I risk my life to save others and the government can’t even provide the resources to lessen the risk’

Survey respondent

But another respondent said nurses are not being told the truth.

‘They’re lying about what they’re actually doing. They’re saying there are tests for staff that aren’t available and they’re sending PPE which isn’t getting further than the ICUs because there isn’t enough,’ they said.

‘Disgusting’ situation in community and care home settings

The situation is ‘disgusting’, a community nurse said.

‘We are going into patients' homes that have symptoms and are positive with COVID-19 and we only have plastic aprons, short disposable gloves and surgical masks. We have to share one tub of chlorine wipes between the whole team and have to keep topping up our small hand gel bottles from bigger bottles. I’m not surprised staff are getting the virus.’

A number of staff from care homes also reported that they felt forgotten when it comes to PPE.

Nurses reported widespread anger at the lack of pandemic planning, and the impact it is having on them and their families.

‘I am a nurse but I am also a mother, daughter, sister, auntie and a niece,’ one said. ‘I risk my life to save others and the government can’t even provide the resources to lessen the risk that I do not become infected or that I am spreading it.’